1. Use an oral syringe

In a study by Yin in 2010*, researchers found that there was an increased chance of making a large dosing error for parents using dosing cups for administering their children’s medication in comparison with using an oral syringe.

Of the 300 parents participating in the study, only 30 per cent were able to measure an accurate dose using a cup with printed markings and only 50 percent were able to measure an accurate dose using a cup with etched markings. Large dosing errors (more than 40 per cent deviation) were made by 26 per cent of parents using the cup with printed markings and 23 per cent of parents using the cup with etched markings.

Oral syringes are preferred as it’s easy to see the measuring scale and accurately measure the dose. This is important given recommended doses for infants can be as low as 0.6ml which means an error of 1ml brought about by inaccurate measurement is significant.

Different dosing devices on the market:

* Yin HS et al. Arch PediatrAdolesc Med 2010; 164(2): 181–6.

2. Go by weight not age

The National Prescribing Service (NPS) recommends weighing children to accurately calculate and administer all types of medicines to children2. If your child is small for his or her age, not using weight to calculate the correct dose can result in administering too much medication. Calls to the Poisons Information Centre about errors in dosing have doubled between 2005 and 2008. Last year 4,300 calls were made, 3,000 of these were due to paracetamol overdosing. Most overdoses are not serious but 400 resulted in hospitalisation.

For parents weighing their child at home, NPS suggests following these steps to get an accurate measurement:

• Weigh yourself

• Hold the child and weigh the two of you together

• Subtract the first weight from the second to get the child’s weight

3. Keep a log

It is also important for parents and carers to keep an accurate log of when and how much medicine was administered. Dosing too frequently over a day is just as much of a pitfall as measuring the wrong amount in the first place.

Internationally, dosing for children is under the spotlight with the UK government recently mandating a new set of doses for paracetamol3. The change is to ensure children get the most optimal dose of paracetamol suitable for their age, and to support parents and carers in giving it to them in the best way.

4. What’s in the Medication?

It is also important to know what is in the medication you are giving to your child, especially the active ingredient. In terms of children’s pain relievers there are two main active ingredients, paracetamol and ibuprofen, and they work differently. Ibuprofen (Nurofen for Children) is a NSAID (Non-Steroidal Anti-Inflammatory Drug) that has pain relieving, anti- inflammatory and fever reducing properties. It works at the site of pain by blocking the production of the chemicals that cause pain, swelling and inflammation in the tissues of the

body. Paracetamol is a non-codeine analgesic. The mode of action of paracetamol is not clearly understood although it is thought to act centrally in the spine and in the brain.

When it comes to paracetamol-based products, there are multiple brand names available so it is important to know which brands contain which active ingredient to reduce the risk of doubling up.

Children and pain relief myths

A commonly held myth is that paracetamol is gentler than other pain relievers. A systematic review of 24 randomised controlled trials and 12 other studies to compare the safety and tolerability of ibuprofen and paracetamol in children by Southey4 showed that ibuprofen, paracetamol and placebo had similar tolerability and safety profiles. At over the counter doses, the study showed no difference in tolerability between ibuprofen and paracetamol.

Tips for choosing a pain reliever for children

When choosing a pain reliever for their children parents should look for one that:

Has an accurate and easy to use dosing syringe.

Tastes good so that children won’t split it out. This is important as parents often re-administer the medication after a child has spat out the first dose having consumed some. This can result in overdosing.

Is specifically formulated for children and has appropriate dosing for their age and weight.